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Hydradenitis Suppuritava

Hydradenitis suppuritava (HS) is a skin condition of varying severity which, thanks to the wonders of the web, is being recognized more and more by both suffers and doctors alike. By sharing as much information as we can about this disease, we can help raise awareness, and lessen some of the prejudices faced by sufferers.

Woman visiting her doctor

HS is typically identified by cyst-like swellings which tend to occur mainly on areas of the body such as the groin, armpits, breasts, buttocks, and other parts where sweat glands are located, and there is lack of circulating air. HS manifests itself in the form of pus or blood-filled lesions, some of which can be the size of a pea, and some of which can swell to the size of a tennis ball. Both have two things in common, though: pain, and scarring.

The onset or flare up of HS usually begins with an itchy, painful swelling deep under the skin. At this point you may not even notice a physical change in the skin, but the area will hurt when pressed on, scratched or rubbed. Quite quickly, however, the skin can become red and inflamed, often rapidly forming a moderate sized, very painful area of swelling which commonly resembles a cyst or boil. Not all HS lesions have pus in them - some can be like a large blood blister, but those can very easily become infected. Regardless of infection or not, HS flare ups can be excruciatingly painful, and quite debilitating for some sufferers, meaning that this condition has a huge, negative impact on their daily lives. During a flare up, a sufferer may literally be incapacitated, taking sick leave from work, school, and/or their usual day to day activities. It is, therefore, quite common for HS sufferers to be prone to bouts of depression.

So the burning question is, what causes HS? Well, sadly, this is where things become cloudy. While there is no doubt whatsoever that HS is indeed a genuinely painful, debilitating condition/disease, no one seems to fully understand the cause of it, and there are many conflicting opinions by scientists and doctors about its origin. One theory is that HS is genetic, and that you're more likely to suffer from it if one or both of your parents has it, although this has not been proven, nor does it answer the question above. Other 'specialists' argue that obesity, diet, and personal hygiene are all contributing factors to this disease, but what little research has been done has shown that there is no link whatsoever between any of these things, and HS.

These so-called 'findings' are what appear to be an age old cliche, though. When symptoms defy a doctor's best diagnosis, it is easy to blame it on the usual suspects: obesity, smoking, poor diet, lack of exercise, and this is all well and good if a patient just so happens to fit into that stereotype. But what about the patients who are a 'normal' weight, eat healthily, get plenty of exercise, and don't smoke - but still suffer with HS? Yep, it's right back to the drawing board.

That isn't to say, though, that a couple of these 'cliches' won't aggravate an HS flare-up. It is only common sense to know that if you have painful, swollen lesions on your inner thighs, then being significantly overweight may mean that your legs chafe together when walking/sitting, thus rubbing on the lesion(s). Poor personal hygiene will also slow down the healing process by allowing infection to remain on the skin, possibly transferring it to other areas. It is therefore best to maintain a good level of hygiene; shower or bathe daily, and wear natural, breathable fibers to minimize sweating or rubbing/friction.

Is Hydradenitis treatable? Not to a satisfactory end, unfortunately. The most practiced method of clinical attack is a long term supply of antibiotics, (usually (Oxy)tetracycline), but while this will only reduce infection from HS, it will not prevent the lesions from occurring in the first place. No particular change in diet has shown to improve the skin, nor has giving up smoking. Some patients opt for an extremely invasive form of treatment: surgery. Surgery to remove the deep roots of HS lesions can actually result in the person being left more scarred than from the lesions themselves. This type of procedure would only be recommended if a person suffers from the occasional swelling, because only the affected area is removed. This doesn't prevent other areas of the body from suffering flare-ups, and a person with multiple, recurring lesions would literally have to have each individual one surgically removed in order to obtain any kind of relief.

Are there any viable home remedies? Trying to explain what Hydradenitis Suppuritava is to someone who hasn't heard of it or seen it before can sometimes be embarrassing for a person, simply because of the incorrect assumptions about the causes of it. Personal confidence and self-esteem can be greatly affected, and this is one of the main reasons why people tend to avoid visiting their doctor when they suspect they have HS. For those individuals, home remedies have been their saving grace, and may even prove to have more positive effects than some of the clinical remedies offered by doctors.

One thing to bear in mind, though, is that HS can cause mild to severe scarring. A bad flare-up can create large pockets of both blood and/or pus, and it is this swelling which causes the intense pain. For this reason, many sufferers find instant relief by releasing the pressure of the lesion, but if this is not done in a sterile manner, infection can easily be spread. Therefore, use a clean, hot compress to force blood flow to the area. By doing this, you will find that the heat will gradually cause the lesion to drain, thus reducing pain, and this is where you must clean the area gently but thoroughly, and preferably cover it with a bandage of some sort. Once a swelling has gone down, it is common for the skin to be left with an indentation, or even a noticeable hole, and unfortunately there is not much that can be done to prevent this kind of scarring from occurring.

Another hugely effective topical remedy for HS swellings is to apply a layer of Vicks Vapor Rub to the area. Do not apply if the skin is broken, though.

The menthol creates a very soothing, cool feeling, and can also aid in the drainage of very swollen lesions. Once applied, cover the area with a bandage.

Bandages themselves can be a huge help in relieving pain from a swelling too - just remember to change them regularly, especially if your skin is infected.

Avoid picking at or poking at your skin when you feel a swelling starting. Sometimes, the swellings will go down by themselves without ever properly forming a cyst/lesion, so it's always best to leave well alone until absolutely necessary, (such as to relieve pain from the pressure of a severe/infected lesion.)

Lack of knowledge and research about Hydradenitis Suppuritava is based upon the assumption that this disease is quite rare, when in fact it is more common than most people think. While you may be embarrassed to show your doctor your skin, just keep in mind that he or she has most likely seen it many times before on other patients, and by keeping record of it, you are helping towards bringing more attention to the disease. It is a condition that both men and women can suffer with at any time in their lives, so if you suspect that you have HS, take a deep breath and mention it to your doctor, and hopefully, in time, it will be a well-researched, well-known about, treatable disease.

To those people who are fortunate to not have ever suffered with HS, it is worth remembering that this condition is not transmittable; in other words, you can't catch it! If one of your friends, or someone in your family suffers with HS, then have empathy, because until you have experienced the debilitating, sometimes unbearable pain that accompanies a flare-up, you will never fully understand just how painful, embarrassing, and life-altering this skin condition can be.

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